Tag Archives: risk adjustment

Getting Risk Adjustment Right Is Key Under Any Individual Market Scenario

If insurers are unable to forecast their overall cost exposure under a risk-adjustment regimen, they might limit their offerings, raise premiums to create a margin of financial protection, or avoid the market entirely.

September 6, 2017

New Guidance On CSR Payments And Risk Adjustment: Answers … And More Questions

The ongoing saga of the cost-sharing reductions just got stranger. On August 10, 2017, the Centers for Medicare and Medicaid Services released at their REGTAP.info website a guidance on risk adjustment methodology and rate filing deadlines.

August 11, 2017

What Could Happen If The Administration Stops Cost-Sharing Reduction Payments To Insurers?

The decision allowing 17 state attorneys general to join the House v. Price cost-sharing reduction litigation complicates the President’s ability to stop the CSR payments, but rumors that he will do so continue. This post focuses on issues that will arise if the administration defunds the CSRs.

August 2, 2017

CMS Releases 2016 ACA Marketplace Reinsurance And Risk Adjustment Data

On June 30, 2017, CMS released the results for the third year (2016) of the reinsurance and risk adjustment programs, two of the Affordable Care Act’s “three R” premium stabilization programs. The 2016 results from the risk corridor program, the “third R” will be announced later this year.

July 1, 2017

Amid ACA Uncertainty, Covered California’s Risk Profile Remains Stable

One of the constant concerns about the ACA and the status of the exchanges involves the average health status of enrollees in these state Marketplaces. Results reveal encouraging news, for amid talk of death spirals, it suggests Covered California continues to attract a healthy mix of enrollees.

May 15, 2017

Capping Enrollment To Save Minnesota’s Individual Market

Minnesota struck a deal with five health plans in the state’s individual market to prevent a market collapse. In June, BCBS announced that it was leaving the individual market with 103,000 individuals left to find a new plan November 1st. It was feared that other plans would quickly follow suit.

October 18, 2016

A Friendly Competition To Increase ACA Marketplace Stability: Calling All Actuaries

Without a doubt, the next administration and Congress will face difficult decisions about how best to address the challenges facing the individual health insurance market. The Robert Wood Johnson Foundation is sponsoring a competition for teams of actuaries to develop solutions to improve that...

October 11, 2016

Judge Rules In ACA Premium Stabilization Program Case; New Hardship Exemption

On August 12, federal judge Rebecca Ebinger entered the first decision in one of the growing number of cases challenging the administration of the premium stabilization programs, denying a motion for a preliminary injunction. CMS also announced a new hardship exemption to the individual mandate.

August 15, 2016

Struggling To Stabilize: 3Rs Litigation And The Future Of The ACA Exchanges

One day, ACA Marketplace plans may cover many of the 11 percent of Americans who remain uninsured. But the three programs---reinsurance, risk corridors, and risk adjustment---that the ACA’s drafters hoped would help stabilize premiums in the revamped markets have not performed as expected.

August 1, 2016

How Funders Can Support Emerging Accountable Care Organizations To Maximize Their Potential

Foundations and others can partner with policy makers and researchers to play a critical role in addressing the remaining challenges for ACOs and in supporting the evolution of promising ACO models.

January 5, 2016